Exercise and Vascular Function

The vascular system does not only supply organs with oxygen and nutrients, but also adjusts blood flow to each organ and blood pressure. The endothelium furthermore controls haemostasis and passage of cells and molecules between blood and tissues. Hence, there is a strong association between loss of vascular function and increased cardiovascular risk. Regular physical activity effectively counteracts and delays the development of vascular dysfunction by exerting shear forces, regulating energy expenditure and thus metabolic function and furthermore by initiating the release of circulating anti-inflammatory and anabolic mediators. This is initiated by a systemic adaptation to the altered muscular energy demands, by anabolic and vasodilative signalling, which allows adaptation of the local and systemic vasculature to increased perfusion demands, as well as by engagement of neuro-humoral and metabolic mechanisms. Exercise parameters such as intensity, type and frequency, differentially address these mechanisms, resulting in heterogeneous effects on metabolic, inflammatory and structural outcomes. In addition, patients’ underlying pathology, fitness level, age and sex modulate the effect of exercise on cardiovascular risk. A number of methods have been developed to study micro- and macrovascular functions as well as overall perfusion, with variance as to their suitability for study purposes and clinical routine. This chapter provides an overview over bio-chemical and cellular mechanisms of vascular dysfunction in cardiovascular diseases and mechanisms by which exercise can prevent the deterioration of vascular function. We also introduce methods to study vascular function in human subjects and discuss their utility in experimental and routine clinical settings.